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Analyst, SIU Certified Coder
Location
Connecticut
Posted
3 days ago
Salary
$43.9K - $93.6K / year
Seniority
Senior
Job Description
Analyst, SIU Certified Coder
CVS Health
• Perform medical claim reviews for the Special Investigations Unit (SIU) • Conduct a comprehensive medical record audit to ensure compliance with coding practices • Provide detailed written summary of medical record review findings • Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. • Research and accurately apply state or CMS guidelines related to the audit • Review and discuss cases with Medical Directors to validate decisions • Assist with investigative research related to coding questions, state and federal policies • Identify potential billing errors, abuse, and fraud • Identify opportunities for savings related to potential cases which may warrant a prepayment review • Maintain appropriate records, files, documentation
Job Requirements
- AAPC Coding certification
- 3+ years of experience in medical coding or documentation auditing
- Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10
- CMS 1500 and UB04 data elements
- Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement
- Experience with researching coding and policies
- Experience with Microsoft products; Excel and Word
- Strong attention to detail and ability to review and interpret data
- Demonstrates strong communication skills
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
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